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Description: Clinical reasoning is the analysis process which assists practitioners when making decisions associated with the evaluation and treatment of a patient. One of the hardest and most intimidating skills for students to learn is how to confidently makeMore...

Clinical reasoning is the analysis process which assists practitioners when making decisions associated with the evaluation and treatment of a patient. One of the hardest and most intimidating skills for students to learn is how to confidently make a clinical decision on their own. Much of this comes with practice and experience, but there are useful skills students need to master in order to effectively come to a diagnosis. Learning Clinical Reasoning outlines the basics of clinical reasoning; the steps in the clinical process, inductive and deductive strategies, data collection and its flaws, and assessing the reliability of clinical evidence.

Foreword

Preface to the Second Edition

Acknowledgments

A Note About the Book's Format

The Processes of Clinical Reasoning

Overview

Introduction

Diagnosis is an Inferential Process

Problem-Solving Strategies

Diagnosis Based on Hypothesis Generation and Testing

Alternate Concepts of Diagnostic Strategies

Therapeutic Principles

Linking Diagnosis and Treatment

Diagnostic Hypothesis Generation

Hypotheses and Cues

The Cognitive Basis of Hypothesis Generation

Hypotheses as a Context

Expertise and Error

Refinement of Diagnostic Hypotheses

Where Refinement Begins and Ends

Context and Diagnostic Classification

Hypothesis Evolution

Sequence of Data Collection

Reducing Diagnostic Uncertainty

The Differential Diagnosis

Relation to Formal Probabilistic Approach

Use and Interpretation of Diagnostic Tests

The Function of Tests

Quantifying Testing Decisions

Sensitivity and Specificity

Bayes' Rule

Testing Principles

Bayesian Revision for Multiple Results

Bayesian Revision for Multiple Diseases With Multiple Attributes

Pragmatic Considerations in the Probabilistic Approach

Interpreting Results

When to Test

The Threshold Concept

The Therapeutic Threshold

Testing Thresholds

Causal Reasoning

Definition

Using a Causal Model

Where in the Diagnostic Process Does Causal Reasoning Fit?

Explaining Relations Between Variables

Diagnostic Verification

Definition

Criteria of Validity

Premature Closure

The Penultimate Result: A Working Diagnosis

Therapeutic Decision Making

Principles

Treatment Under Conditions of Uncertainty

When the Value of Therapeutic Choices is Close

Incommensurate Options

Quantitative Therapeutic Decision Making

Examining Evidence

Introduction

Evidence-Based Medicine

Asking Questions

Searching for Evidence

Summarizing and Appraising Evidence

Applying the Evidence

Practice Guidelines

Cognitive Errors

Scope

Classification

Some Errors may have a Psychological Origin

The Nature of Cognitive Errors

Cognitive Biases in the Laboratory

Consequences of Cognitive Biases

Strategies for Avoiding Cognitive Errors

Some Cognitive Concepts

Cognitive Science

Studying Mental Processes

The Structure of Memory

Search Strategies

Characteristics of Expertise

Learning Clinical Problem Solving

Facts Versus Process

Pedagogic Principles

A Specific Example

The Goal Should Determine the Format

Learning by Instantiation

Learning Clinical Problem Solving Versus Problem-Based Learning

Cognition at the Bedside: A Set of Examples

Introduction to the Cases

Diagnostic Hypothesis Generation

Generation of Diagnostic Hypotheses

Hypothesis Triggering by an Expert

A Diagnostic Coup

A Quick and Accurate Solution

Better Late Than Never

A Hit After a Miss

The Critical Role of Context in the Diagnostic Process

A Masked Marauder

A Serious Lack of Focus

Refinement of Diagnostic Hypotheses

What is a Differential Diagnosis?

An Orderly, Sequential Approach

Weak Reasoning: Diagnosis by Drug Reaction

Narrowing Down the Diagnostic Options

A Picture is Worth a Thousand Words

Strategies of Information Gathering

A Fatal Flaw in Sutton's Law

How to Disregard Red Herrings

Discrimination: The Problem of Look-Alikes

Location, Location, Location

Use and Interpretation of Diagnostic Tests

Interpreting a Negative Test Result

Diagnosis and the Risks of the Primrose Path

Searching for a Pony

Interpreting Hoofbeats: Can Bayes Help Clear the Haze?

Short-Circuiting the Diagnostic Process

The Bypass on the Way to the Bypass

It is What You Believe That Counts

Renal Rescue by Reverend Bayes

A Diagnostic Fluke

Surprise!

Tripping Over Technology

The Probability of a Probability

Causal Reasoning

Judging Causality

Post Hoc, Ergo Propter Hoc

The Case for Causal Reasoning

The Tricky Task of Attributing Causation

The Right Answer for the Wrong Reason

Diagnostic Verification

A Point-By-Point Dissection of Clinical Reasoning

Leaving No Stone Unturned

Verification

A Meticulous Approach

A Diagnostic Quandary

Diagnosis by Fiat

Iron Pyrite and Diagnostic Confirmation

Therapeutic Decision Making

The Surgeon Opts to Operate: Why?

Treat or Keep Testing?

Watch and Wait, or Operate?

An Apple or an Orange?

Examining Evidence

A Difficult Tradeoff

Making Judgments When the Evidence is Not Definitive

Using and Citing Published Evidence

A Little Math Makes the Medicine Go Down

A Rewarding Pursuit of Certainty

Treating Before Knowing

Cognitive Errors

A Defective Detective

Remedies for Faulty Hypothesis Generation

A Disaster Averted

Derailed by the Availability Heuristic

Wrong Diagnosis, Wrong Tests, Wrong Treatment

Reconsidering Failures of Therapy

The Cheetah and the Snail

A Collection of Cognitive Diagnostic Errors

Some Cognitive Concepts

A Message about Methods

Memory: How We Overcome its Limitations

Diagnosis and the Structure of Memory; Disease Polymorphism and Mental Models

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